Current State and Future Trends to Optimize the Care of Chronic Kidney Disease in African Americans

Am J Nephrol. 2017;46(2):176-186. doi: 10.1159/000479481. Epub 2017 Aug 5.

Abstract

Background: African Americans (AAs) suffer the widest gaps in chronic kidney disease (CKD) outcomes compared to Caucasian Americans (CAs) and this is because of the disparities that exist in both health and healthcare. In fact, the prevalence of CKD is 3.5 times higher in AAs compared to CAs. The disparities exist at all stages of CKD. Importantly, AAs are 10 times more likely to develop hypertension-related kidney failure and 3 times more likely to progress to kidney failure compared to CAs.

Summary: Several factors contribute to these disparities including genetic and social determinants, late referrals, poor care coordination, medication adherence, and low recruitment in clinical trials. Key Messages: The development and implementation of CKD-related evidence-based approaches, such as clinical and social determinant assessment tools for medical interventions, more widespread outreach programs, strategies to improve medication adherence, safe and effective pharmacological treatments to control or eliminate CKD, as well as the use of health information technology, and patient-engagement programs for improved CKD outcomes may help to positively impact these disparities among AAs.

Keywords: African Americans; Call to action; Care coordination; Chronic kidney disease; Chronic kidney disease interventions programs; Genetic determinants; Health disparities; Social determinants; Sustainable technology.

MeSH terms

  • Apolipoprotein L1 / genetics
  • Black or African American / genetics
  • Black or African American / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data
  • Health Services Accessibility / trends*
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / statistics & numerical data
  • Healthcare Disparities / trends
  • Humans
  • Patient Education as Topic
  • Patient Participation / trends
  • Patient-Centered Care / statistics & numerical data
  • Patient-Centered Care / trends
  • Pharmacogenomic Variants
  • Renal Dialysis / statistics & numerical data
  • Renal Dialysis / trends*
  • Renal Insufficiency, Chronic / ethnology
  • Renal Insufficiency, Chronic / genetics
  • Renal Insufficiency, Chronic / therapy*
  • Socioeconomic Factors
  • United States

Substances

  • APOL1 protein, human
  • Apolipoprotein L1